| NPI | 1578750154 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES WABBERSEN Therapist 972-623-2629 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX 029202505) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1157230) |
| Enumeration Date | 2007-09-27 |
| Last Update Date | 2007-10-27 |